Development and validation of an instrument to measure beliefs in physical activity among (pre)frail older adults: An integration of the Health Belief Model and the Theory of Planned Behavior

Development and validation of the Chinese version of the adult sedentary behavior reduction intention questionnaire based on the theory of planned behavior

PROM: The Chinese version of the Adult Sedentary Behavior Reduction Intention Questionnaire, a 16-item self-reported tool based on the Theory of Planned Behavior (TPB), was developed to assess adults' intentions to reduce sedentary behavior.

MEASUREMENT PROPERTY

Internal consistency is used to measure the reliability of the questionnaire, while content and structural validity are studied to assess its validity.

DESIGN

A mixed-methods exploratory sequential design with two phases.

SAMPLE

Adults aged over 18 years diagnosed with coronary heart disease, with a total daily sedentary time exceeding 6 h, normal cognitive function, and willingness to participate in the study were included.

METHODS

The study was conducted in two phases. In Phase 1, an initial item pool was developed through a literature review and refined using two rounds of Delphi expert consultation. Expert positivity, authority levels (Cr), coefficients of variation (CV), and Kendall's W coefficient were calculated to assess representativeness, credibility, and consensus. A pilot study evaluated face validity and finalized the scale. In Phase 2, a cross-sectional study involving 316 participants was conducted to assess psychometric properties. Reliability was evaluated using Cronbach's α and split-half reliability, while content validity was assessed using the content validity index (I-CVI). Construct validity was examined through confirmatory factor analysis (CFA).

RESULTS

Phase 1 resulted in a preliminary questionnaire with four dimensions and 16 items. Sixteen experts completed two rounds of Delphi consultation, with high response rates (85% and 94.1%) and authority levels (Cr = 0.88 and 0.91). Consensus was strong (CV = 0.05 ~ 0.23; Kendall's W = 0.338 and 0.382, p < 0.001). Phase 2 validation showed a Cronbach's α of 0.967, with individual dimensions ranging from 0.911 to 0.950. I-CVI ranged from 0.813 to 1. The adjusted model indices met the fitting criteria.

CONCLUSIONS

The developed questionnaire is a reliable and valid tool for assessing Chinese adults' intentions to reduce sedentary behavior. Grounded in TPB, it provides a theoretical foundation for future intervention studies aimed at addressing sedentary lifestyles.

Exploring the mechanism of change in exercise behavior during a theory-based exercise intervention among community-dwelling (pre)frail older adults: A stepped wedge cluster randomized trial

This study evaluated the effectiveness of a theory-based exercise intervention on exercise beliefs and behavior, and clarified the underlying mechanism of the exercise intervention among community-dwelling (pre)frail older adults. A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented to 149 participants. The positive effects were significant on exercise beliefs (β = -1.630 - 3.500, P < 0.05) and exercise behavior (β = 0.851, P < 0.001), and most of them persisted at 12- and 24-week postintervention. Furthermore, perceived barriers (β1β2 = 0.118, P = 0.037) and descriptive norms (β1β2 = 0.144, P = 0.047) mediated the relationship between exercise intervention and exercise behavior. The theory-based exercise intervention improves exercise beliefs and behavior, and perceived barriers and descriptive norms play a crucial role in increasing exercise behavior among the target population.

Effectiveness of a theory-underpinning exercise intervention among community-dwelling (pre)frail older adults: A stepped-wedge cluster-randomized trial

OBJECTIVES

To evaluate the effectiveness of a theory-underpinning exercise intervention among Chinese community-dwelling (pre)frail older adults, and the impacts of intervening late as opposed to intervening early.

METHODS

This was a stepped-wedge cluster-randomized trial. Participants were enrolled from six communities in a county of central China from January to November in 2021 (n = 149). A 12-week exercise intervention based on the integration of Health Belief Model, Theory of Planned Behavior and Health Action Process Approach was implemented among 149 community-dwelling (pre)frail older adults during the study period. The primary outcomes were frailty and muscle mass, muscle strength and physical performance. Secondary outcomes included physical disability, fear of falling, cognitive function, depressive symptoms, social support and quality of life. Assessments were conducted at baseline and at 12, 24 and 36 weeks. A multilevel regression model was used for statistical analysis.

RESULTS

The positive effects were statistically significant on frailty (β = -1.166, p = 0.016), muscle mass (β = 1.499, p = 0.005), handgrip strength (β = 14.758, p < 0.001), physical performance (Short Physical Performance Battery, β = 6.043, p < 0.001), physical disability (Activities of Daily Living: β = 0.462, p = 0.043; Instrumental Activities of Daily Living: β = 0.693, p = 0.049;) and fear of falling (β = -1.490, p = 0.003), cognitive function (β = -0.466, p = 0.011), depressive symptoms (β = -0.541, p < 0.001), social support (β = 27.661, p < 0.001), physical (β = 2.413, p = 0.013) and mental (β = 7.837, p < 0.001) components of quality of life at 0-week postintervention, and most of them persisted at 12- and 24-week postintervention. The effectiveness significantly differed by the time of interventions on muscle mass (β = -1.217, p = 0.002), 5-time chair stand test (β = -1.172, p = 0.018), cognitive function (β = 0.600, p = 0.014) and mental component of quality of life (β = -12.679, p = 0.002).

CONCLUSION

The theory-underpinning exercise intervention has positive immediate and persistent effects on frailty, frailty-related characteristics as well as physical, mental and social functioning among Chinese community-dwelling (pre)frail older adults. Late intervention attenuated the significant intervention effect.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100041981.

Effect of home-based and remotely supervised combined exercise and cognitive intervention on older adults with mild cognitive impairment (COGITO): study protocol for a randomised controlled trial

INTRODUCTION

Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting.

METHODS AND ANALYSIS

This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants' real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit.

ETHICS AND DISSEMINATION

The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300073900.

Prediction of rear-seat belt use: Application of extended theory of planned behavior

OBJECTIVES

Rear-seat belts have been shown to significantly reduce the severity of road vehicle collisions and fatalities. However, their use by rear-seat passengers is significantly less than that by front-seat passengers. Thus, the psychological factors underlying individuals' decision to wear a seat belt in the rear seat require further investigation.

METHODS

An extended theory of planned behavior (eTPB) was used to examine individuals' behavior of wearing a rear-seat belt. An online survey was conducted and a total of 515 valid questionnaires were collected in China.

RESULTS

While attitude, descriptive norms, and law enforcement all have a significant effect on individuals' intention to wear a seat belt in the rear, subjective norms and perceived behavioral control do not. Individuals' attitudes toward wearing a seat belt in the rear seat are significantly influenced by law enforcement and behavioral intention, but not by perceived behavioral control. The mediation effect analysis reveals that law enforcement has the greatest overall effect on behavior, followed by attitude and descriptive norms.

CONCLUSIONS

The results of this paper contribute to more effective recommendations to improve the use of rear seat belts and to safeguard rear seat passengers.

Predictors of older people's intention to engage in cycling violation behaviour with an integrative model

In China, bicycles are a popular mode of transportation for senior citizens. A disproportionate number of traffic-related fatalities and injuries involve cyclists. The violation of cycling laws is a significant cause of cyclist crashes. Few studies have analyzed the cycling violation behaviour of seniors. Therefore, it is essential to examine the factors that influence older individuals' intention to engage in cycling violation behaviours. In this study, the effects of social-demographic characteristics, the exogenous constructs in the health belief model (HBM), and the theory of planned behaviour (TPB) on senior cyclists' violation intention were investigated using hierarchical regression analysis. Interviews were conducted with older cyclists in urban areas of Wuhan City, all above 60 years of age. The results showed that very little variance in behavioural intention could be explained by social-demographic factors. The TPB has a significantly greater capacity than the HBM to explain variance in behavioural intention. Perceived susceptibility, perceived benefit, cues to action, subjective norm and attitude significantly impacted behavioural intention, whereas perceived severity, perceived barrier and self-efficacy did not.

Examining physical activity participation barriers among adults 50 years and older: a scoping review

Background

Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools.

Objectives

Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older.

Methods

We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties.

Results

The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible.

Conclusion

The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.

A theory-driven exercise intervention among community-dwelling (pre)frail older adults: Protocol for a stepped-wedge cluster-randomized trial

AIM

This study is aimed to evaluate the effectiveness of a theory-driven exercise intervention for Chinese community-dwelling (pre)frail older adults, and to clarify the underlying mechanisms of the exercise intervention in this population.

DESIGN

A stepped-wedge cluster-randomized trial.

METHODS

A stepped-wedge cluster-randomized trial will be conducted among (pre)frail older adults at six communities in a county of central China. A 12-week multicomponent exercise intervention based on the integration of the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB) will be implemented to all participants during the study period. The primary outcomes are frailty, muscle mass, muscle strength and physical performance. Secondary outcomes include beliefs in exercise, exercise behaviours and other physical, mental and social functioning. Assessments will be conducted at baseline and at week 12, 24 and 36. A multilevel regression model will be used to evaluate the effectiveness of exercise interventions. A multilevel mediation model will be used to clarify the underlying mechanisms of this exercise intervention.

DISCUSSION

This study is expected to provide an effective and practical mode for exercise interventions among Chinese community-dwelling (pre)frail older adults, and contribute to the existing evidence in this field.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100041981.

Associations of fruit & vegetable intake and physical activity with poor self-rated health among Chinese older adults

BACKGROUND

Despite the existing literature highlights the central roles of sociodemographic factors, fruit & vegetable (F&V) intake, and physical activities for maintaining good health, less is known about the associations in the Chinese context. This study attempted to explore the associations of servings of F&V intake and levels of physical activities with poor self-rated health (SRH) among Chinese older adults.

METHODS

Data were drawn from the Study on Global Ageing and Adult Health-China (SAGE-China) issued by the World Health Organization and included 7560 respondents aged ≥60 years in China. After screening out the potential confounding factors, multiple logistic regression models were adopted to explore the associations of sociodemographic factors, servings of F&V intake, and levels of physical activities with poor SRH.

RESULTS

Among the sample, nearly a quarter reported poor health status. There were significant gender differences in the case of servings of F&V intake and levels of physical activities. Logistic regressions indicated that higher fruit intake was associated with lower likelihood of vigorous level of physical activity as compared to zero intake. Likewise, higher vegetable intake (≥10 servings) was associated with a higher likelihood of vigorous & moderate level of physical activity when compared to lower intake (≤ 4 servings). Higher fruit intake was associated with a lower likelihood of poor SRH. Similarly, vegetable intake (5 servings: AOR = 0.69, 95%CI: 0.58-0.83; 6-9 servings: AOR = 0.72, 95%CI: 0.59-0.87) was significantly associated with poor SRH. Additionally, vigorous level of physical activity (AOR = 0.79, 95%CI: 0.65-0.97) and vigorous fitness/leisure (AOR = 0.57, 95%CI: 0.39-0.84) were significantly associated with poor SRH.

CONCLUSION

This study suggested that older adults with high fruit intake had lower probability of performing vigorous & moderate level of physical activity, while those with high vegetable intake had higher probability of performing vigorous & moderate level of physical activity. Likewise, the older adults with high F&V intake and higher probability of performing vigorous level of physical activity, walk/bike activity, and vigorous/moderate fitness/leisure had less likelihood to face the risk for poor SRH outcomes. The appropriate servings of F&V intake and levels of physical activity should be highlighted.